Response Prevention

Description of the Strategy

Response prevention refers to a practice in which a learned behavioral reaction to a stimulus or event is blocked or inhibited. The purpose of response prevention is to break the association between the learned behavioral reaction, which typically is one that is harmful or maladaptive in the case of response prevention, and the antecedent or consequent events that maintain the response. Decades of theoretical and empirical work on the principles of associative learning have demonstrated that behaviors are influenced by the events that precede and follow them and that adding, removing, or changing these events will modify behaviors. In some instances, however, it is not possible or desirable to change the antecedent or consequent events. Therefore, it may be necessary to prevent the behavior from occurring altogether.

Response prevention is commonly used in the behavioral treatment of intense anxiety, perhaps most often in the treatment of obsessive-compulsive disorder (OCD). According to the cognitive-behavioral model of OCD, certain types of thoughts (e.g., contamination by dirt or germs) may become aversive through the process of classical conditioning. Subsequently, the individual may perform compensatory behaviors that decrease the anxiety or discomfort [Page 490]associated with the aversive thoughts (e.g., self-cleaning to rid oneself of the perceived contamination). If these behaviors do, in fact, decrease anxiety or discomfort, they are likely to increase in frequency and intensity via negative reinforcement. Over time, with repeated reinforcement, these compensatory behaviors can become very frequent and intense and often take the form of specific “rituals” performed to ward off the obsessive thoughts and experienced anxiety. The performance of such ritualistic behaviors will decrease the probability that an individual's anxiety will subside naturally, as the individual never learns that these behavioral responses are not necessary to decrease the experienced anxiety.

In the behavioral treatment of OCD, the individual is repeatedly exposed to the feared stimulus or event for a prolonged period of time. Through this repeated exposure, the individual learns that the perceived consequences of confronting the feared stimulus do not occur, and thus he or she obtains new information regarding the nonthreatening nature of that stimulus. For this exposure to occur and ultimately result in the extinction of the individual's fear, all attempts to escape from the feared stimulus or engage in compensatory behaviors must be blocked or prevented. Therefore, in the treatment of OCD, response prevention, or “ritual prevention,” allows the individual to learn the stimulus is not dangerous, and the experienced anxiety will decrease naturally, without the performance of such responses.

Although response prevention is most commonly associated with the treatment of OCD, this procedure also has a place more generally in the treatment of other anxiety disorders and nonanxiety-related behavior problems. Indeed, exposure to feared stimuli is a major component of the behavioral treatment of all anxiety disorders. Whenever such exposure is performed, it is important that the individual's attempts to escape or avoid the feared stimulus are prevented, so that habituation to the stimulus can occur and anxiety can decrease. Thus, the clinician must employ response prevention to block escape and avoidance from exposure situations. Response prevention may also be used in the treatment of nonanxiety-related behavior problems. For example, in the treatment of impulsive or aggressive behaviors, a major component of many treatments is teaching the individual to inhibit impulsive or aggressive responses to perceived provocation in favor of no response or a less aggressive response.

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